Healthcare Provider Details

I. General information

NPI: 1174640759
Provider Name (Legal Business Name): A.I.M. PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 01/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 ALDER AVE
SUMNER WA
98390-1321
US

IV. Provider business mailing address

415 ALDER AVE
SUMNER WA
98390-1321
US

V. Phone/Fax

Practice location:
  • Phone: 253-216-3600
  • Fax: 253-862-2675
Mailing address:
  • Phone: 253-216-3600
  • Fax: 253-862-2675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT5418
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00005418
License Number StateWA

VIII. Authorized Official

Name: MR. MICHAEL ANDREW EGBERT
Title or Position: PRESIDENT
Credential: PT
Phone: 253-216-3600